维持性血液透析患者残余肾功能与症状困扰关系的研究

The association between residual renal function and symptom burden in maintenance hemodialysis patients

目的 探讨维持性血液透析患者残余肾功能(residual renal function,RRF)变化对症状困扰的影响.方法 纳入复旦大学附属华山医院行维持性血液透析患者152例,根据24h尿量进行分组:RRF组(24h尿量≥200 ml)及无RRF组(24h尿量<200ml).收集透析相关数据,应用“透析症状指数量表”评估症状困扰,用多因素线性回归及Logistic回归分析RRF与症状困扰的关系.结果 ①症状困扰发生率前5名:难以熟睡、性欲降低、感觉疲惫和缺乏活力、皮肤干燥、瘙痒.症状困扰严重程度前5名:骨骼关节疼痛、难以入睡、焦虑、悲伤、便秘.②多因素线性回归发现,残余肾功能与症状困扰严重程度总分呈负相关(t=-2.670;P=-0.009).且RRF组患者的呕吐、腹泻、不宁腿、足部麻木刺痛、感觉疲惫和缺乏活力、焦虑等症状困扰发生率低(OR值分别为0.071,0.064,0.053,0.123,0.187,0.132;Z值分别为-2.200,-2.130,-2.260,-2.540,-2.920,-2.410;P值分别为0.028,0.033,0.024,0.011,0.003,0.016).结论 有残余肾功能的血液透析患者症状困扰严重程度更低.

Objective To explore the association between residual renal function(RRF)and symptom burden in maintenance hemodialysis(MHD)patients.Methods A total of 152 MHD patients were enrolled in this study.Patients were divided into two groups according to urine volume.Their dialysis related data were collected.Symptom burden was evaluated by Dialysis Symptom Index.Multvariate liner regression and multivariate logistic regression analyses were used for exploring the association between RRF and symptom burden.Results①The burdens of top five occurred symptoms were trouble staying asleep,decreased libido,tired,dry skin and itching.The burdens of top five severe symptoms were bone or joint pain,insomnia,anxious,sad and constipation.②Multivariate linear regression revealed that RRF was negatively correlated with the total score of symptoms(t=-2.670,P=0.009)and patients with RRF had lower prevalence of several symptom burdens,including the burdens of vomiting(OR=0.071,z=-2.200,P=0.028),diarrhea(OR=0.064,z=-2.130,P=0.033),restless legs(OR=0.053,z=-2.260,P=0.024),foot numbness and tingling(OR=0.123,z=-2.540,P=0.011),tired(OR=0.187,z=-2.920,P=0.003)and anxious(OR=0.132,z=-2.410,P=0.016).Conclusion MHD patients with RRF had less symptom burdens.